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Synovial fluid: sampling

ISSN 2398-2950

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Synonym(s): Arthrocentesis, Joint fluid collection

Introduction

  • An essential adjunct to the investigation of joint disease; aims to differentiate degenerative, infectious and immune-mediated conditions.

Uses

  • Articular effusions, polyarthritis, joint stiffness, joint pain.
  • Investigation of pyrexia of unknown origin.

Normal synovial fluid is of small volume (<1 ml in dogs), clear, viscous, pale or pale straw colored and does not clot on standing.

Advantages

  • Immediate subjective assessment of color and viscosity.
  • Differentiates major classifications of joint disease, ie infectious from non-infectious and inflammatory (neutrophilic) from degenerative disorders.
  • Multiple joints may be sampled.
  • Does not usually require general anesthesia.

Disadvantages

  • Yields small volumes of fluid, therefore may need to sample more than one joint.
  • All joints require analgesia.
  • Multiple sampling of a single joint may confuse interpretation due to iatrogenic bleeding.

Technical problems

  • Requires some experience for sampling of some joints, eg coxofemoral.

Alternative techniques

  • Synovial membrane biopsy Biopsy: synovia, can provide more definitive diagnosis in some cases of inflammatory arthropathy and synovial tumors.
  • Arthroscopy, in large joints for visualization of joint surfaces and collection of biopsy material.
  • Arthrotomy can give a more complete assessment of traumatic injuries to the hard and soft joint tissues.

Time required

Preparation

  • 5 min site preparation.

Procedure

  • Minimum 5 min depending on joint to be sampled and experience of technician in locating and entering joint space.

Decision taking

Criteria for choosing test

  • Radiographs that indicate pathology in specific joint.
  • Obviously enlarged joint.

Risk assessment

Do not enter joint with overlying skin infection or lesion.

  • Additional diagnostic information for difficult to diagnose lameness or fevers.

Requirements

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Preparation

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Technique

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Aftercare

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Montgomery R D, Long I R Jr., Milton J L et al (1989) Comparison of aerobic culture, synoval membrane biopsy and blood culture medium in detection of canine bacterial arthritis. Vet Surg 18 (4), 300-303 PubMed.
  • Pedersen N C (1978) Synovial fluid collection and analysis. Vet Clin North Am (3), 495-499 PubMed.